‘A really valuable service’: GP-led COVID-19 respiratory clinics

Anastasia Tsirtsakis

30/07/2020 4:45:55 PM

As case numbers continue to spike, a new RACGP resource is designed to guide the establishment and ongoing management of GP-led respiratory clinics.

GP at testing clinic
Since March, 143 GP-led respiratory clinics have been set up across Australia under the National Health Plan. (Image: AAP)

Victoria hit a daily record of 723 new coronavirus cases on Thursday 30 July, as well as 13 deaths.
A rise in confirmed cases in regional communities has seen the mandatory requirement for face coverings extended across regional Victoria, effective as of 11.59 pm Sunday 2 August.
Social distancing restrictions were also further tightened in six local government areas south-west of Melbourne – Colac-Otway, Greater Geelong, Surf Coast, Moorabool, Golden Plains, and the Borough of Queenscliffe – where residents will no longer be able to visit people or have visitors at their home from 11.59 pm Thursday 30 July.
The latest numbers are a significant jump since the state recorded 73 new cases on 1 July, serving as a stern warning for NSW, which recorded 18 new cases, while Queensland had three.
More than 500 Victorian healthcare workers currently have coronavirus, according to the ABC, which has reported it understands at least two – including a GP in his 30s who got contracted coronavirus at a screening clinic – have been in intensive care.
As part of the Federal Government’s pandemic response, 143 GP-led respiratory clinics have been set up across Australia under the National Health Plan to offer comprehensive care to patients with mild-to-moderate respiratory symptoms.
To address the needs of the health workforce, the RACGP’s new resource – Guiding principles for the establishment and ongoing management of GP-led COVID-19 respiratory clinics – covers:

  • governance
  • location and accessibility
  • infection control (including clinical and other equipment, clinic layout, protocols for staff/contractors, use of personal protective equipment [PPE], and environmental cleaning)
  • triage and workflow
  • assessment for COVID-19
  • testing
  • management (including patient education, hospital and specialist referrals, requesting further pathology and diagnostic imaging, and prescribing follow-up, documentation and communication)
  • quality and safety.
Dr Penny Burns, Deputy Chair of the RACGP Specific Interests Disaster Management network, was involved in its development.
‘There’s a lot of free license given to each respiratory clinic because it has to be appropriate to the local community, and appropriate to what the resources are and what the situation is,’ she told newsGP.
‘We wanted to make sure that there were a few guiding principles so we’ve got that consistency, flexibility and adaptability, which is what GPs are doing an amazing job with during this pandemic.
‘But [the resource also includes] just a few things for them to check. I know I want to make sure I’m doing absolutely everything right, so it’s reassuring for me to know that I can go through and say, “Okay, we’re doing this, we’re doing that, or we could do that a bit better” and have some guidance as to what’s happening.’
Dr Burns is based at a respiratory clinic in Sydney’s Northern Beaches, where she has witnessed firsthand the ‘crucial gap’ respiratory clinics fill.
‘If they weren’t there, it would be a really heavy load on EDs [emergency departments], it would be harder for the community to access that care, and we would have people, most likely, not actively accessing that care until later,’ she said.
Dr Sarah Lewis, who is also based in a GP-led respiratory clinic, agrees. She believes such clinics have also been crucial in protecting other GPs who are either vulnerable or lacking PPE.
Dr Lewis’ clinic, converted from a specialist centre in Port Melbourne, sees 120–160 patients a day.
‘We’re really proud and really pleased that we’ve been able to offer this service to our local community and surrounds,’ she told newsGP.
‘Given some of the significant pathology that we’ve actually detected, we know that we provide a really valuable service.
‘We’ve dealt with asthma, detected pneumonia, ischemic heart disease, we picked up pulmonary embolisms, we’ve just found so much pathology that we know that if these people were left without a facility to attend or if they avoided a hospital for fear of the infections, there would have been some bad outcomes.’
Dr Lewis says other doctors have seen the benefits, and embraced the service.
‘We get a lot of local referrals to our respiratory clinic because the doctors and patients know that we offer a GP service,’ she said.
‘So they’re getting what they need from an assessment perspective, but we hand over [for non-COVID related respiratory issues] to their regular GP for urgent further management or ongoing care as required, and we encourage patients to see their regular GP for follow-up.’

Dr Penny Burns hopes the perception that GPs do not ‘really have a role to contribute’ in disaster management is starting to change.  

Dr Burns says maintaining that continuity of care is particularly important during a health crisis.
‘When the patient comes in, there’s a lot of time spent on making sure that the local GP is documented, and they’re copied in on any results that are done,’ she said.
Earlier this month, Acting Chief Medical Officer Professor Paul Kelly issued a letter to GP-led respiratory clinics outlining that resources would only be focused on symptomatic presentations.
Dr Lewis says while this may prove frustrating for some people, it makes sense.
Dr Burns agrees.
‘There’s huge numbers [of people who] have got symptoms that need to be tested in advance of those [who] are asymptomatic,’ she said.
‘If we start stepping outside what the guidelines are, which are not just for asymptomatic individuals, we’re going to potentially end up with issues around availability of reagent, processing times increase, and it’s going to make it harder to then focus our attention on the ones that we really need to be focusing on.’
While the GP-led respiratory clinic model is not entirely new – New Zealand had a similar set up in its response to the swine flu in 2009 – Dr Burns says the RACGP’s new resource is the first to highlight the overarching principles of such clinics.
‘I see this as being really important,’ she said.
‘And I’m not trying to be negative, but I don’t think this is the last pandemic that we will see.
‘With some other infectious disease, you could imagine a respiratory clinic popping up locally. So just one or two for a smaller outbreak in one particular localised area. I think that could definitely be a new model.’
When Dr Burns first started working in the space of disaster healthcare some 15 years ago, she says the general sentiment was that GPs ‘didn’t really have a role to contribute’.
She hopes that, that perception is starting to change.
‘GPs are local – they know their patients, they’re trusted by their patients, and they can also feed back what’s happening locally in areas where other healthcare professionals may not be at the time,’ she said.
‘They’ve got their eyes and ears in the community and they can report back early, so that something that’s beginning to occur can actually, possibly, be mitigated.
‘And so I think the combination of these really, unfortunately, very severe bushfires, and then this pandemic, which we’re still in the middle of, has really highlighted the strength of general practice and the fact that we need to have GPs strongly embedded in the systems.’
The new resource ‘Guiding principles for the establishment and ongoing management of GP-led COVID-19 respiratory clinics’, can be accessed on the RACGP website. It also includes templates for a completed encounter, to notify patients who test negative to COVID-19, and for pathology requests.
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Dr Duncan MacWalter   31/07/2020 8:03:51 AM

There will need to be upscaling of these clinics now we've lost telehealth rebates for people not seen in person for 12 months (regardless of longer term relationships with the practice, or ongoing relationships with other family unit members).

Those with mild disease should still be tested. There are 3h+ queues at these clinics which will put many off. They probably won't want to pay for the teleconsult (even if that means they skip the queue).

Dr Ian Mark Light   31/07/2020 9:49:22 AM

Very Welcome initiative by the GPs and the College .
Hope they can also have fresh air flow in the clinics going to include the probability of the airborne spread of COVID 19 Theory .
As spring arrives there will be more allergy though so this has to be factored in by air filtration air conditioning .
Also there might well be more asthma and exacerbation of COPD so nebulisation might be needed but this can be done in one allotted room with an open window opening to a safe space .
There are viral filters that can be placed on the expiratory stem of a nebuliser and with a mouth piece for inhalation aerolisation would theoretically less .
Intramuscular adrenalin is the other treatment till the ambulance arrives more for asthma than severe COPD .
In Urgent care clinics in the USA they advise strongly against patients lying supine if short of breathe sitting up is far better.